Managing Digestive Side Effects
Though digestive symptoms like nausea, loss of appetite, diarrhea, and mouth sores are common side effects of kidney cancer treatment, they can often be managed with medications, dietary changes, and other strategies.
Nausea
Many people think nausea is an unavoidable part of cancer treatment that they simply have to accept. “One of the biggest advances over the last few decades is not just in cancer treatment itself, but in how we treat side effects,” says Braun.
Supportive care has come a long way, and there are now several antiemetic drugs (medications that can help prevent or treat nausea). If one doesn’t work, there are others to try, he says.
If you notice that a treatment causes nausea almost every time you take it, don’t wait until symptoms begin. Braun recommends talking with your healthcare team about taking an antiemetic beforehand to help prevent nausea from developing.
The strategies below can also help:
- Eat smaller meals throughout the day, instead of three large ones, since an empty stomach can make nausea worse.
- Choose bland foods that are easy on your stomach, such as crackers, toast, clear broth, or plain yogurt.
- Sip liquids slowly throughout the day. Cold, clear liquids like ginger ale, broth, or tea may be easiest to handle.
- Avoid fried, greasy, or spicy foods, and eat foods cool or at room temperature so their smell isn’t as strong.
- Rest while sitting upright for at least an hour after each meal.
Loss of Appetite
Another common side effect of kidney cancer treatment is loss of appetite. It can happen because of the tumor or because targeted therapies called tyrosine kinase inhibitors (TKIs) can reduce your appetite or change the way foods taste, making eating less appealing, Braun says. Some people find that foods taste metallic or less flavorful. Even if you don’t feel hungry, it’s important to get enough calories, protein, and fluids to help your body maintain its strength and weight during treatment.
Yet, when you have no appetite, a full plate can feel defeating, says Alison Tierney, RD, founder of Wholesome LLC, a telehealth nutrition practice supporting people through cancer treatment and survivorship, based in Oconomowoc, Wisconsin.
Rather than trying to eat three large meals, she recommends having something nourishing every two to three hours and eating on a schedule. This may mean setting a reminder on your phone, especially if treatment has dulled your hunger cues.
Make those bites count, Tierney says, by choosing foods that provide plenty of protein and calories in a small amount, such as:
- Smoothies with nut butter and ground flaxseed
- Hummus with soft pita
- Oatmeal made with soy milk
- Avocado on toast
- Bean-based soups
Diarrhea
Changes in your bowel habits are common side effects of kidney cancer treatment, particularly with TKIs and immunotherapy. Many people develop diarrhea, though for some, it’s constipation instead, Braun says.
“There are effective medications that can help manage diarrhea, so if the first doesn’t work, another might,” he notes. An over-the-counter antidiarrheal such as loperamide (Imodium A-D) may be appropriate for some people, but don’t start taking it without first checking with your care team.
Once you start treating diarrhea, the goal is to avoid overcorrecting. Braun says if a medication relieves diarrhea but causes constipation, notify your care team who can help fine-tune your treatment schedule or dosage, so that you’re not swinging from one problem to the other.
What you eat and drink can also help manage diarrhea. Tierney suggests the following dietary adjustments:
- Choose foods with soluble fiber, which helps firm up stools, such as oats, bananas, applesauce, peeled potatoes, and white rice.
- Drink fluids and replace electrolytes throughout the day to help prevent dehydration.
- Cut back on caffeine, sugar alcohols (sweeteners found in sugar-free gum, candy, and other diet products, often listed as sorbitol, xylitol, or mannitol), and very high-fat foods, including fried foods, pizza, and creamy sauces.
Mouth Sores
While they can be uncomfortable and make it difficult to eat, drink, and sometimes maintain your weight, mouth sores are often manageable.
Braun recommends starting with a baking soda rinse or a saltwater rinse to soothe irritation. One commonly used recipe is to mix one-quarter teaspoon of baking soda and one-eighth teaspoon of salt into one cup (8 ounces) of warm water, swish it around your mouth for about 30 seconds, then spit it out. Repeat about four times a day, or as recommended by your cancer care team. Recipes vary, so ask your nurse or healthcare team to write down what they prefer.
If the sores are getting in the way of eating, ask your care team about “magic mouthwash,” Braun says. This prescription rinse helps numb the sores to make eating more comfortable, and you can use it about 30 minutes before meals. For some treatments, a prescription steroid mouth rinse may also help reduce inflammation if other measures aren’t helpful, he notes.
Tierney also recommends choosing soft, moist foods, such as:
- Smoothies
- Oatmeal
- Mashed potatoes
- Yogurt
- Blended soups
Avoid acidic, spicy, salty, crunchy, or very hot foods, and skip alcohol-based mouthwashes because they can worsen irritation. Drinking through a straw may also help direct liquids away from sore areas, she says.
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